Abstract
Coronary artery bifurcation lesions are complex and several classifications are presented to describe them. Recently, the Medina classification has been proposed. This classification uses binary values for characterization of stenosis. Flow conditions according to Medina classification have not been described. In this paper, bifurcation lesions corresponding to anatomical Medina lesion classification are compared on the basis of flow and Wall Shear Stress (WSS). Computational models of healthy and stenosed coronary artery bifurcations ((1, 1, 1), (0, 1, 1) and (1, 0, 1)) with moderate and severe stenoses of 50% and 75% diameter were analyzed. The results showed that, flow conditions vary in bifurcation lesion types according to the clinically-oriented Medina classification. The flow in SB of bifurcation was dependent of the Medina lesion type and was more affected in lesion type (1, 0, 1). The magnitudes of WSS on the inner and outer walls of SB of bifurcation lesion (1, 0, 1) in post-stenotic region and along the arterial wall were smaller than bifurcations lesions (0, 1, 1) and (1, 1, 1) respectively. Our results suggest that SB of bifurcation lesion (1, 0, 1) is more prone to atherosclerosis progression compared to types (0, 1, 1) and (1, 1, 1).
Highlights
From clinical practice, it is known that coronary artery bifurcations are regions where the flow is strongly perturbed, and is prone to the development of atherosclerotic lesions
The present study is motivated by the need to understand the flow condition and Wall Shear Stress (WSS) distributions in various bifurcation lesion types in a coronary artery bifurcation
We have investigated the flow ratio and time-dependence patterns of WSS resulting from the numerical simulation of pulsating hemodynamic flows in healthy and stenosed coronary artery bifurcations
Summary
It is known that coronary artery bifurcations are regions where the flow is strongly perturbed, and is prone to the development of atherosclerotic lesions. There are seven coronary bifurcation lesion classification schemes in the literature [6,7,8,9,10,11,12,13]. These classifications are based on the presence or absence of significant angiographic stenosis within the three vessels of the bifurcation. The classification by Medina is simple and does not need to be memorized even though it provides all the information contained in the other classifications In this classification, the bifurcation is divided into three segments: the main branch proximal (MBP), the main branch distal (MBD), and the side branch (SB). The Medina classification is essentially an anatomical classification
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